MetroPlusHealth provides the highest quality healthcare services to residents of Bronx, Brooklyn, Manhattan, Queens and Staten Island through a comprehensive list of products, including, but not limited to, New York State Medicaid Managed Care, Medicare, Child Health Plus, Exchange, Partnership in Care, MetroPlus Gold, Essential Plan, etc. As a wholly-owned subsidiary of NYC Health + Hospitals, the largest public health system in the United States, MetroPlusHealth's network includes over 27,000 primary care providers, specialists and participating clinics. For more than 30 years, MetroPlusHealth has been committed to building strong relationships with its members and providers to enable New Yorkers to live their healthiest life.
Position Overview
The Quality Management (QM) Analytics Manager will be responsible for supervision of the QM Analytics Team, which includes four Analysts. The team independently maintains the HEDIS/QARR data repository that informs reporting of HEDIS, QARR, and PCMH data to NYS DOH and CMS. To that end, the team carries the responsibility of ensuring the monthly rates and annual HEDIS and QARR submissions are timely, and quality checked for accuracy and completion. This includes managing the end-to-end process of integrating claims, provider, member, encounter, and supplemental data into quality measure rates. To successfully perform these duties, the QM Analytics Manager collaborates with all levels of the organization including our largest provider, NYC Health + Hospitals and works closely with appropriate vendors. The vendors include, but are not limited to: HEDIS software vendor, member rewards vendor, communications vendor, and provider and member portal vendor, as well as the CMS and NY state-mandated vendors for data transmission.
The QM Analytics Manager also retains responsibility for the development of program forecasting models and actual and predictive quality program dashboards to ensure provider pay for performance program budgets and QM/Plan quality goals are identified, tracked, and met. The role will also mentor and train analytics staff on all applications and processes and develop strategic plans to ensure deadlines are met, while still maintaining data integrity. Additionally, this position guides and works with Quality Improvement Specialists to ensure data requests are aligned with project needs, interpretation of data is correctly interpreted & reported. The position may also be responsible for duties tied to the development of new programs and initiatives as assigned by the Director of QM Analytics.
